Treatment
Chemotherapy Sequence
Recommendation 2.1
➤ For T2N0 (AJCC 8th) NPC patients, chemotherapy is not routinely
recommended, but may be offered if there are adverse features, such
as bulky tumor volumes or high EBV DNA copy number. (Moderate
Recommendation; EB-B-I)
Recommendation 2.2
➤ For T1-2N1 (AJCC 8th) NPC patients, concurrent chemotherapy may be
offered, particularly for T2 N1 patients. (Moderate Recommendation;
EB-B-I)
Recommendation 2.3
➤ For Stage III–IVA (except T3N0) (AJCC 8th) NPC patients, induction
chemotherapy should be offered in addition to concurrent
chemoradiotherapy. (Strong Recommendation; EB-B-H)
Recommendation 1.5
➤ For NPC patients who have undergone induction chemotherapy, the pre-
induction scan should be fused with the post-induction CT simulation
dataset to illustrate the initial disease extent. The gross tumor volume
should generally follow the pre-induction tumor extent, especially within
bony anatomy. (Moderate Recommendation; IC-B-I)
Recommendation 1.6
➤ The delineation of elective nodal volumes should follow international
consensus guidelines and cover the bilateral neck from the
retropharyngeal lymph nodes to level IV and V. Level 1b may be omitted
in prophylactic volume unless there is involvement of the anterior half
of the nasal cavity or if there are level II lymph nodes with extranodal
extension or size greater than 2 cm or bilateral involvement. Omission
of lower neck volume in the uninvolved side of the neck may be
considered if the neck contains no equivocal lymph node(s). (Moderate
Recommendation; IC-B-I)
